Neurology Flashcards
When can an individual resume strenuous activity after a concussion
After resolution of symptoms and recovery of memory as well as cognitive functions
Abortive migraine therapy antiemetics and adverse effects of them
Metoclopramide, chlorpromazine, prochlorperazine, adverse effects include extrapyramidal symtpoms such as acute dystonic reactions, IV diphenhydramine can be given to prevent these reactions
Acute management of cluster headache (2)
- 100% oxygen
- Antimigraine medications can help during acute attack like sumatriptan
Prophylaxis prevention against migraine headache vs cluster headache
Propranalol vs verapamil first line
Idiopathic intracranial hypertension definition
Increased CSF pressure with no clear cause evident on neuroimaging, seen most often in obese women of childbearing age, presents with headache that is pulsatile and worse with straining, funduscopic exam reveals papilledema bilaterally and can have visual changes or field loss that can lead to blindness if not treated, diagnosed with a CT prior to LP to rule out intracranial mass, and LP demonstrates increased CSF pressure with otherwise normal CSF, treated first line with acetazolamide and weight loss and sometimes furosemide or steroids as adjunct
CSF findings in MS, guillain barre, bacterial meningitis, viral meningitis
MS - high IgG
Guillain barre - high protein with normal WBC/cell count
Bacterial meningitis - high protein with WBC, decreased glucose
Viral meningitis - normal glucose, increased WBC’s particularly lymphocyte predominance
Most common cause of neonatal bacterial meningitis
Group B strep
Most common cause of acute bacterial meningitis in adult
Strep pneumoniae
Management for bacterial meningitis
Antibiotics such as vancomycin + ceftriaxone and dexamethasone, post exposure prophylaxis with cipro to prolonged close contacts
2 most common causes of aseptic (viral) meningitis
Coxsackievirus and echovirus
Encephalitis definition
Infection of brain parenchyma, most commonly caused by HSV1 and will have meningeal symptoms but also presence of altered mental status and focal neural deficits (hemiparesis, sensory deficits, etc), PCR testing of CSF fluid most accurate to determine herpes encephalitis, treated with IV acyclovir
Treatment option for essential tremor
Propranolol
Essential tremor vs parkinson disease
Tremor affects head and voice in essential tremor and is also intentional worsened with movement as opposed to a resting tremor characteristic of parkinson’s
Treatment of parkinson disease (3)
- Levodopa carbidopa combo most effective for treatment, can cause dyskinesia and long term use associated with waning effectiveness
- Dopamine agonists like bromocriptine can be used first line in younger patients <65 to delay use of levodopa
- Amantadine low potency can help with early symptoms
ALS characteristics presentation
Asymmetric limb weakness initially, difficulty chewing, aspiration, mixed upper and lower motor neuron signs, (spasticitiy, hyperreflexia, but also fasciculations, muscle atrophy, weakness), sensation, eye movement, sphincter funciton, and sexual function are spared, usually fatal within 3-5 years due to respiratory failure
Drug given for involuntary movement disorders like managing huntington’s and tourettes
Tetrabenazine
Tourette disorder definition
Idiopathic movement disorder characterized by vocal and motor tics usually onset in childhood and idiopathic, most often motor tics are first, diagnostic criteria requires onset prior to age 18 and not caused by other substance or medical condition seeing multiple motor and 1 or more vocal tics not required concurrently for >1 year since the first tic, maangement is primarily habit reversal therapy first line and most don’t need medical management but tetrabenazine is an option
Cerebral palsy definition
CNS disorder with msulce tone, movement, or postural abnormalities with spasticity being the hallmark
Treatment of choice for restless leg syndrome
Dopamine agonists like pramipexole or ropinirole
Work up for restless leg syndrome
Iron work up as can be part of underlying causes
Bell palsy clinical manifestation
Sudden onset ipsilateral hyperacusis for 24-48 hours followed by unilateral facial weakness or paralysis involving the forehead such as unable to lift affected eyebrow, wrinkel forehad, smile, drooping of corner of mouth, only affects the face
Bell palsy treatment (2)
- No treatment other than supportive
- Prednisone possibly
Guillain barre syndrome presentation
Symmetric ascending weakness and sensory changes, if severe could cause respiratory failure but most recover within a year without permanent disability
Management of guillain barre
Plasmapheresis or IVIG first line
Clinical presentations of myasthenia gravis
Generalized muscle weakness and ocular weakness (diplopia and ptosis usually first presenting symptom) that is worsened with repeated muscle use and at the end of the day
Myasthenia gravis diagnosis
- Acetycholine receptor antibodies initial test of choice
- In inpatient emergent setting tensilon (edrophonium) test (brief improvement after administration) or icepack test
Management of severe myasthenia gravis vs long term medical management
Plasmapheresis or IVIG, long term acetylcholinesterase inhibitors like pyridostigmine or neostigmine first line
Lambert Eaton syndrome definition
Proximal muscle weakness that improves with repeated muscle use (may see difficulty arising from chair), tested with antibody assay, associated with small cell lung cancer and other malignancies so goal is to treat underlying malignancy but can also use pyridostigmine
Most common type of MS
Relapsing remitting
Physical exam findings in MS
- Upper motor neuron signs like spasticity, babinksi, hyperreflexia, muscle rigiidty
- Positive lhermitte’s sign
- Spinal cord symptoms like bladder, bowel, or sexual dysfunction
Best initial and most accurate test for MS, what is one other one if this test is negative?
MRI with gadolinium demonstrating hyperintense white matter plaques
LP if negative MRI dmeonstrating increased IgG and oligoclonal bands
Management of acute exacerbation of MS and prevention of relapse or progression
IV high dose glucocorticoids first line
Beta interferon
Most common and aggresive primary malignant CNS tumor in adults
Glioblastoma
Alzheimer dementia pathophysiology hypotheses
Amyloid extra cellular protein deposition senile plaques, tau neurofibrillary tangles,
Clinical manifestation of alzheimer dementia
Short term memory loss often first symptom, progresses to long term memory loss and cognitive deficits, disorientation, behavioral changes, gradual by nature
Preferred neuroimaging test for alzheimer dementia (even though it is a clinical diagnosis)
MRI
Medical management for alzheimer dementia (2)
-Acetycholinesterase inhibitors like donepezil or rivastigmine and NDMA antagonist like memantine as adjunct or monotherapy in moderate to severe disease
Vascular dementia definition
Brain disease due to chronic ischemia and multiple infarcts (lacunar infarcts), hypertension most important risk factor, sees sudden decline of function in a stepwise progression of symptoms, clinical diagnosis but work up is similar to alzheimer disease and often an MRI is done
Frontotemporal dementia (Pick’s disease) definition
Localized brain degeneration of frontotemporal lobes, sees marked changes in social behavior, personality, and language, often onset is earlier than alzheimer’s, disinhibition or socially inappropriate behaviors
Diffuse lewy body disease definition
Dementia characterized by diffuse presentation of lewy bodies everywhere in comparison to parkinson disease where they are localized, core features occur early like visual hallucinations, episodic delirium, parkinsonism, dementia is a late finding, management is difficult
Todd’s paralysis definition
Neurologic deficit after a seizure that mya last for up to 24 hours, can be mistaken for a stroke as it might just affect one arm
What 2 antiepileptic medications are safest in pregnancy
Lamotrigine and levetiracetam
Status epilepticus definition
Single continuous seizure lasting 5 min or greater or more than 1 seizure within a 5 min period without recovery between episodes, considered an emergency
Status epilepticus management (2)
Benzos like lorazepam preferred, phenytoin if no response or loading to prevent recurrence
1 risk factor for lacunar infarct and ischemic stroke
Hypertension
TIA management in non cardiogenic causes
Antiplatelet therapy, aspirin, clopidogrel
Management of ischemic stroke acutely and outpatient
Within 3 hours of symptom onset, alteplase if no contraindications (BP 185/110 or greater, recent bleeding, bleeding disorder, recent trauma), possible mechanical thrombectomy
Outpatient aspirin therapy should not be started until 24 hours after time of thrombolytic therapy but then begin aspirin and clopidogrel as well as a statin regarldess of LDL level
Most common artery affected in ischemic stroke
Middle cerebral artery
MCA ischemic stroke manifesetations
Arm deficits greater than leg, facial involvment of lower half of face only (still can raise forehead!!!), aphasia
ACA ischemic stroke manifestations
Leg deficits gerater than arm
PCA ischemic stroke manifestations
Vertigo, vomiting, visual changes such as diplopia
Epidural hematoma definition
Rupture most often of middle meningeal artery, 3 phases, loss of consciousness followed by lucid interval follwoed by neurologic deterioration (talk and die syndrome), biconvex lens shaped hyperdenisty seen in temporal area, managed with hematoma evacuation to prevent death
Subdural hematoma definition
Rupture of cortical bridging vein after blunt trauma, usually presents with gradual increase in generalized neurologic symptoms, CT dmeonstrates concave crescent shaped banana shaped bleed with possible midline shift, managed either clinically if small or surgical if large midline shift or severe
Subarachnoid hemorrhage finding on LP
Xanthochromia (yellow or pink color to CSF due to breakdown of RBcs
Management of subarachnoid hemorrhage
supportive, nimodipine reduces cerebral vasospasms which improves outcomes neurologically, prevention of rebleeding is done with endovascular surgical clipping
Compressive axial load on back of head fracture and how is it managed?
Jefferson (burst fracture of c1) such as jumping into pool, managed with external immobilization for 6-12 weeks
Odontoid process of axis (C2) is at great risk of…
….malunion and is an unstable fracture, increases odds of needing surgical repair
Extreme hyperextension injury of the skull, atlas, and axis
Hangman C2 fracture, unstable
Anterior cord syndrome mechanism, deficits
Burst fracture or flexion injury, sees worsened lower extremity motor deficits than upper, worst outcome
Central cord syndrome mechanism, deficits
Hyperextension injuries, upper extremity affected worse than lower in a cape distribution, good recovery
Brown sequard syndrome mechanism, deficits
Unilateral hemidisection after penetrating trauma most often, ipsalateral motor and vibration/proprioception, contralateral pain and temp deficits, great prognosis
